22. European Stroke Conference 372 © 2013 S. Karger AG, Basel Scientific Programme 169 Interesting and challenging cases DILEMMA OF INDICATION FOR THROMBOLYSIS IN A PATIENT WITH ACUTE ISCH-EMIC STROKE TREATED WITH A NOVEL ORAL ANTICOAGULANT A. FOLYOVICH1, V. Varga2, K.A. Béres-Molnár3, K. Vadasdi4, D. Bereczki5 Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY1, Depart-ment of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY2, Department of Neu-rology and Stroke, Szent János Hospital, Budapest, HUNGARY3, Department of Neurology and Stroke, Szent János Hospital, Budapest, HUNGARY4, Department of Neurology, Semmelweis Uni-versity, Budapest, HUNGARY5 Background: Increasing age of the population is associated with a higher rate of cerebrovascular diseases, and every 6th stroke is the consequence of atrial fibrillation. In atrial fibrillation vitamin K antagonists are routinely used to prevent cardioembolic strokes. Thrombolytic treatment (rt-PA) has established efficacy in acute ischemic stroke, but in anticoagulated patients its use is contraindicat-ed for those with an international normalized ratio (INR) ≥ 1.7. Recently, novel oral anticoagulants have become available. With conventional methods, however, it is difficult to assess the coagula-tion status of patients on these new treatments. Patient and method: A 56-year-old male patient was admitted with signs of left hemispheric stroke that had developed 50 minutes earlier (NIHSS: 7). Cranial CT detected no acute ischemic lesion. He was considered for thrombolysis. Nine months prior his admission dabigatran (110 mg BID) was introduced because of atrial fibrillation. Result: Although the patient had no other exclusion criteria as well, considering the prolonged thrombin time we refrained from thrombolysis. CT (24 hours later) demonstrated a 5.4x4.3x4.4 cm infarction in the left fronto-temporo-parietal region involving the left basal ganglia as well. Repeated coagula-tion tests 5 days after stroke, with unchanged anticoagulant treatment found two-fold higher throm-bin time and activated partial thromboplastin time compared to the values found in the acute stage. During the treatment, the right-sided facial palsy improved, and the apraxia of the right upper limb resolved. Speech performance and writing improved. Conclusion: Routine coagulation tests (throm-bin time and APTT) do not reliably reflect the coagulation features of a patient, therefore there is an urgent need to develop reliable biomarkers and an adequate guideline to help decision making regarding thrombolysis in those who develop their strokes while on one of these new oral anticoagu-lants.
Karger_ESC London_2013
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